In Medicare Part D Failures, an Opportunity

July 31, 2006

As has been long awaited and discussed herein, many elderly are reaching the Medicare Part Donut-hole as evidenced by articles in both the Sunday New York Times and the Washington Post. Both papers profile and document the surprise and fear that seniors who are going to the pharmacy to pick up their drugs and are getting the shocking news that coverage has stopped. For some reason, public discussion of this failure of the program wildly upsets its proponents, as if no one was going to notice this rather serious gap in coverage.

The Administration response is also couched in this mindset. They seem to feel that because the program provided something, people shouldn’t be upset when it provides nothing.

The Post article describes a woman who went to the pharmacy for a diabetes treatment for which she had been paying $20.00. Her cost rose to over $175. She is quoted as saying she nearly fainted.

Dr. Mark McClellan who moved to oversee the Center for Medicare and Medicaid Services after a brief stint at FDA, embodies the administration’s weak response by offering the following advice for seniors. First, he suggests that they switch get generic drugs and then the expense will come down, completely ignoring the fact that many are on medications that don’t have generic equivalence, or that they may already be using generics. Second, he said, they should take advantage of patient assistance programs, thereby handing the hot potato to industry.

And here is the opportunity. Where government fails (and it is), industry can step in to offer some solutions, even if temporary. For example, when Katrina struck and the government abdicated its responsibility, many in private industry seized the chance to make good by providing support.

According to the reports in the Post, many of the seniors who are hitting the donut hole are getting social security checks that make them ineligible for many of the industry sponsored patient assistance programs. The industry should seize this opportunity and ensure their coverage. By doing so, there would be good will reaped. Correspondingly, a failure to help seniors who earn too much for the programs but have small incomes could serve to reigniting policy battles around importation, price controls and the like. Lending a helping hand for temporary assistance could help all boats to rise.

After all, Dr. McClellan says that next year, the seniors who don’t like their coverage can opt to get coverage that gets them through the donut hole next year, assuming they make it.

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About This Blog

Eye on FDA is published by Mark Senak of FleishmanHillard's Washington, D.C. office. The thoughts and ideas in this blog and postings are strictly my own and are not screened by my employer. Everything posted on this blog is my personal opinion and does not necessarily represent the views of FleishmanHillard or its clients.